Recurrent Donation - Donate - Foundation for Senior Services

Entering your contact information allows the organization to acknowledge your generous contribution. Specify the contribution amount and an optional comment. Depending on the configuration, you may also be able to specify if this should be reported as anonymous (although your contact information is still required.) Click Proceed to Payment to finalize and pay by credit card or by printing an invoice and mailing a check.

warning In addition to your name, please enter your address, phone number and email address. This will allow us to contact you if necessary.

Contact Information

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Donate as an

IndividualBusiness/Organization

First Name

Middle Initial

Last Name

Address 1

Address 2

City

Country

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State/Province

Zip/Postal Code

Phone

Mobile Phone

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Email Address

Organization

Work Title

Contribution Details

Contribution Date

Amount ($)

Amount must be equal to or above $ 25.00

Contribution in

Comment

How do you want your name to appear in the contribution records?

Notify

Name

Address Line 1

Address Line 2

City

Country

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State/Province

Zip/Postal Code

Matching Gifts

Will you mail the form?

Yes No

Employer Name

Employer City

Employer State

Employer Contact Person

Employer Contact Phone

Matching Terms

Contribute to Recurrent Donation

Contribution Details

Notify

Matching Gifts

Additional Info